In-Person Intake Process Guideline for Providers

Information Collection

1. Rula collects the required registration (ex. patient name, address, and phone #), however there are limitations on mandated patient information that can be collected prior to the first session. Important: Be certain to ensure that you obtain the patient’s emergency Contact Person (ECP) as this information is not a required step within registration. As you know, clients may be uncomfortable sharing ECP information for a number of reasons. However please assist your client in understanding the necessity and ensure that you obtain this information prior to beginning treatment.
2. For in-person patient registration, the patient is asked the DTO question “Do you have thoughts of harming others?” When DTO question is affirmative, the provider’s options include:
   1. If provider is comfortable with DTO in-person care:
      • Proceed w/in-person tx, provider encouraged to:
      • Further assess the level of risk (provider screener)
      • Consider telehealth or hybrid if indicated
      • On-going monitoring of risk levels 
   2. If provider is comfortable with DTO telehealth care:
      • Switch to a telehealth session, provider encouraged to:
      • Further assess the level of risk (provider screener)
      • Consider in-person or hybrid if indicated
      • On-going monitoring of risk level
   3. If provider is not comfortable with DTO tx, provider encouraged to:
      • Submit for rematch ("High Acuity" is scheduled to be a rematch drop-down choice for providers beginning 11/25. While we do not have a way of matching high-acuity patient to high-acuity provider, this will allow us to offer the next provider additional support)
      • Cancel Session

(Note: If the provider chooses to not see the person in-office, they are expected to outreach the patient and provide clarity and understanding regarding their clinical recommendation)

3. Prior to your in-person session, Rula proactively gathers required information and makes an effort to gather clinical information, including potential clinical risks by requesting the patient complete intake information and MIC completion. To support autonomy, patients are not required to complete these steps prior to their first session with their provider.
4. During the intake phase of treatment, providers are encouraged to work with new patients to complete clinical information, MICs, and any additional risk assessments as clinically indicated. 
5. For clinical risk management, the Rula HELP Guide contains risk assessments for SI and HI and guidelines in managing clinical risk events. Providers are expected to maintain robust systems for ongoing risk monitoring and management.
6. During the in-person’s patient registration, the patient is asked a DTO queProvider guide for affirmative Danger to Others (DTO) options:
   1. When affirmative for DTO (including no answer), provider options are:
      1. If provider is comfortable with DTO in-person care:
         1. Proceed w/in-person tx, provider encouraged to:
            • Further assess the level of risk (provider screener)
            • Consider telehealth or hybrid if indicated
            • On-going monitoring of risk levels 
      2. If provider is comfortable with DTO telehealth care:
         1. Switch to a telehealth session, provider encouraged to:
            • Further assess the level of risk (provider screener)
            • Consider in-person or hybrid if indicated
            • On-going monitoring of risk level
      3. If provider is not comfortable with DTO tx, provider encouraged to:
         • Submit for rematch ("High Acuity" is scheduled to be a rematch drop-down choice for providers beginning 11/25. While we do not have a way of matching high-acuity patient to high-acuity provider, this will allow us to offer the next provider additional support)
         • Cancel Session

High-Risk Patient Identification & Recommendations

1. As discussed above, risk assessment occurs during the intake process, including the provider's in-person evaluation/clinical impression.  After completing the initial clinical evaluation, providers may recommend the patient receive a Higher Level of Care (HLoC) or referral to a specialist. When this happens, providers are encouraged to offer the patient clarity for understanding the clinical recommendation as best practice.
2. Patient autonomy is respected. Although patient choice ultimately prevails over clinical recommendations, providers are encouraged to set firm boundaries surrounding the scope of their practice and their clinical recommendations. We encourage providers to emphasize collaborative decision-making between their patient and provider.

Patient wellbeing and understanding

1. Patient appointments and terminating therapy
   1. How many transition sessions to expect
   2. Circumstances under which the provider might terminate services (ex. non-payment, repeated no-shows, needed care is out of scope)
   3. Scheduling appointments, punctuality expectations, cancellations, and no-shows
2. Patient and office safety
   1. Clarity on what to do in case of crisis/ emergencies, including after-hours information, 24 hr hotline resources (Proto), and when to call 911 or go to the nearest emergency room.  
   2. Pt agreement to office rules/safety re: 
      • No weapons on premises
      • Safety of self and others at office
      • Prohibit the use of alcohol or illicit drugs before or in sessions
      • Pt agreement to limits of confidentiality, HIPAA compliance, and office privacy 
      • Waiting Room Policy